A doctor's or pharmacist's religious beliefs may determine whether you get treated or not. That is, if you're lucky enough to have health care in the first place.
More than a dozen states are considering new laws to protect health workers who do not want to provide care that conflicts with their personal beliefs, a surge of legislation that reflects the intensifying tension between asserting individual religious values and defending patients' rights.
About half of the proposals would shield pharmacists who refuse to fill prescriptions for birth control and "morning-after" pills because they believe the drugs cause abortions. But many are far broader measures that would shelter a doctor, nurse, aide, technician or other employee who objects to any therapy. That might include in-vitro fertilization, physician-assisted suicide, embryonic stem cells and perhaps even providing treatment to gays and lesbians.
At least nine states are considering "right of refusal" bills that are far broader. Some would protect virtually any worker involved in health care; others would extend protection to hospitals, clinics and other health care facilities. Some would protect only workers who refuse to provide certain health services, but many would be far more expansive.
At least five of the broad bills would allow insurance companies to opt out of covering services they find objectionable for religious reasons. A sixth state, Pennsylvania, is considering a bill designed for insurers.
"These represent a major expansion of this notion of right of refusal," said Elizabeth Nash of the Guttmacher Institute, a nonprofit organization that studies reproductive health issues and is tracking the legislation. "You're seeing it broadening to many types of workers -- even into the world of social workers -- and for any service for which you have a moral or religious belief."
So, there are religious insurance companies, too? Do we really want to give more power to denial of coverage to insurance companies?
That's not all. These laws seems to allow health care workers to pick and choose which "moral issues" they will or will not treat.
Opponents fear the laws are often so broad that they could be used to withhold health services far beyond those related to abortion and embryos.
"The so-called right-to-life movement in the United States has expanded its agenda way beyond the original focus on abortion," Uttley said. "Given the political power of religious conservatives, the impact of a whole range of patient services could be in danger."
Doctors opposed to fetal tissue research, for example, could refuse to notify parents that their child was due for a chicken pox inoculation because the vaccine was originally produced using fetal tissue cell cultures, said R. Alto Charo, a bioethicist at the University of Wisconsin.
"That physician would be immunized from medical malpractice claims and state disciplinary action," Charo said.
Advocates for end-of-life care are alarmed that the laws would allow health care workers and institutions to disregard terminally ill patients' decisions to refuse resuscitation, feeding tubes and other invasive measures.
"Patients have a right to say no to CPR, to being put on a ventilator, to getting feeding tubes," said Kathryn Tucker of Compassion and Choice, which advocates better end-of-life care and physician-assisted suicide.
Others worry that health care workers could refuse to provide sex education because they believe in abstinence instead, or deny care to gays and lesbians.
"I already get calls all the time from people who have been turned away by their doctors," said Jennifer C. Pizer of the Lambda Legal Defense and Education Fund, who is representing a California lesbian whose doctor refused her artificial insemination. "This is a very grave concern."
The list is endless really. This kind of thing might shield physicians and workers after the fact also, as in the DNR orders. Stick a tube in your dying grandma even though she had an expressed DNR order, and then claim "religious beliefs" as the reason for ignoring a patient's expressed wishes.
Perhaps patients should receive a list of everything that any doctor or health care worker will or will not perform when coming into a clinic, pharmacy or hospital. Perhaps they facilities should be required to notify the patient, and have replacement personnel available who will take care of the person's needs without judgment. If they want to carry the load of workers who refuse to do certain jobs, they can pay the added cost of having staff on who will.